비알콜성 지방간 : 임상소견과 초음파소견의 비교

채희복,김미성,박선미,성노현,윤세진 충북대학교 의학연구소 2000 忠北醫大學術誌 Vol.10 No.1

연구목적 : 최근 건강검진이 널리 시행됨에 따라서 지방간 환자가 많이 발견되고 있으며 이에 대한 사람들의 관심이 증대되고 있다. 본 논문에서는 지방간 환자의 임상적인 특징을 살펴보고 위험요인과 예후에 관련된 인자들을 규명해 보고자 하였다. 연구대상 및 방법: 1998년 2월부터 2000년 3월까지 충북대학교 병원에 내원한 환자 중 초음파로 지방간을 진단받은 65명의 환자를 대상으로 하였다. 후향적으로 진료기록을 검토하였으며, 전화로 체중, 키, 음주력, 약물복용력, 관련증상 유무를 확인하였다. 초음파상 지방간의 중증도와 대상환자들의 체질량지수, 혈청 ALT치의 상승, 기저질환, 관련 임상 증상들간에 상관성이 있는지를 비교분석 하였다. 결과: 체질량지수와 초음파상 지방간의 중증도간에는 유의한 상관관계가 관찰되었다. 혈청 ALT치를 80 IU/L를 기준으로 두 군으로 나누어 지방간의 중증도와 비교하여 본 결과 중증도가 심할수록 혈청 ALT치의 이상소견이 더 높은 빈도로 관찰되었다. (P < 0.01) AST/ALT비는 초음파상 중증도와 역의 상관관계를 나타내었다. (P < 0.01) 소량음주군과 비음주군의 두 군으로 나누었을 때 지방간의 중증도가 심한 군에서 소량음주군이 보다 더 많이 포함되는 경향을 보였다 (P = 0.052) 첫 초음파 검사 시행 시점부터 평균 32개월의 기간이 경과한 뒤 추적검사가 가능하였던 9명의 환자 중 6명에서 무변, 3명에서 호전이 관찰되었다. 결론: 본 연구의 결과 초음파상 지방간 중증도가 심한 환자에서 더 자주 혈청 ALT치의 상승이 관찰되었다. 지방간 환자 중에서 간내 지방축적이 심할수록 염증을 동반할 기회가 많아진다고 생각된다. 이러한 간내 염증괴사소견의 동반은 좋지 않는 예후를 시사하므로 간조직검사등의 적극적인 진단과 비 알콜성지방간염에 대한 조기대응이 필요하다고 생각된다 아울러 지방간 이환기간과 간내 염증과의 상관성을 증명하기 위한 후속연구가 더 필요하다고 생각된다. Background/purpose : Nonalcoholic fatty liver disease can be found more frequently than before due to a high fat diet and a sedentary life style. The aim of this study was to compare clinical characteristics and outcomes of patients with different sonographical grade of the nonalcoholic fatty liver. Methods : 65 patients were diagnosed as nonalcoholic fatty limier patients by abdominal solography from Feb. 1998 to Mar. 2000. We reviewed medical records and confirmed the clinical data by phone. We compared the sonographical grade of the fatty liver with such clinical data as BMI, serum ALT level, underlying diseases and associated symptoms. Results: 1) There was a significant correlation between the BMI and the sonographical grade of the fatty liver . 2) The more severe the sonographical grade of the fatty liver, the higher the serum ALT level was. 3) There were significant inverse correlations between the AST/ALT ratio and the sonographical grade of the fatty liver. 4) Out of the 9 patients whose status could be assessed by sonography or biochemical tests after about 3 years, 3 patients improved and the other 6 patients showed no interval change. Conclusion : Both the amount of excessive fat and the duration of the fatty liver are considered to be the risk factors of nonalcoholic steatohepatitis. We confirmed the association between the sonographical grade of the fatty liver and the serum ALT level by this study, but the association between the duration of the fatty liver diesease and the nonalcoholic steatohepatitis needs to be studied more in the future. The nonalcoholic steatohepatitis showing necrosis or a Mallory body may take an aggressive course leading to cirrhosis and liver related death. Therefore, a liver biopsy and active therapeutic intervention is necessary, early and properly

결장을 이용한 식도재건 환자에서 경피 내시경하 결장루술 1예

채희복,윤수인,홍장수 충북대학교 의과대학 충북대학교 의학연구소 2003 忠北醫大學術誌 Vol.13 No.2

뇌졸중, 파킨슨 병, 척수신경손상 등으로 연하관련 근육들의 협동운동장애가 발생한 환자에서 흡인성 폐렴이 반복되거나 경장영양이 곤란하게 된다. 이러한 경우에 경피내시경하 위루술(percutaneous endoscopic gastrostomy)은 이들 환자의 생명을 유지하는데 매우 중요한 역할을 해 왔다. 위궤양 혹은 위암 등으로 위절제술을 받은 환자에서 위루술 대신에 부득이 경피내시경하 공장루술(direct percutanous endosopic jujunostomy)이 시행되었던 경우는 국내외에 몇 례의 보고가 있다. 본 증례는 과거 후두암 때문에 후두부식도절제술 후 결장 끼어듬(colon interposition) 수술을 받은 65세 남자 환자로 최근 좌측중대뇌동맥 경색으로 연하장애가 발생되었다. 저자들은 이 환자에게 지속적인 영양공급을 위하여 경피내시경하 결장루술을 합병증 없이 시행하였기에 보고하는 바이다. Dysphagia is a loss of coordination in the swallowing musles. It has occurred in patients with cerebrovascualr accident, head injury, Parkinson's disease or cervical cord injury. Dysphagia results in nutritional deficiency or repeated aspiration pneumonia. Percutaneous endoscopic gastrostomy have helped these patients to maintain healthy and save lives. Several cases of direct percutaneous endoscopic jejunostomy have been reported in patients who received gastric resection for a stomach cancer or peptic ulcer hemorrhage. A 65-year-old male patient, who was suffering from dysphagia, whose symptom was caused by left middle cerebral infarction. He was referred to the division of gastroenterology for the provision of permanent enteral feeding. His esophagus had been resected and replaced with a part of colon because of laryngeal cancer 5 years ago. We could not approach the stomach because the angle of anastomosis was acute and the colonic graft was long. We performed direct percutaneous endoscopic colostomy without any complications. Herein, we report on this successful case.

퍼머제의 중금속 농도에 관한 연구

윤복연,문덕환,박명희,황용식,함성애,손병철,김대환,이창희,김휘동,이채언 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.5

Objective : This study was conducted to prepare the fundamental data on heavy metal concentration in hair permanents agents and to prevent the health impairment due to heavy metal. Methods and Material : The author determined of 5 heavy metals(Pb, Cr, Mn, Ni, and Cu) concentration hair permanent agents in the market with flameless atomic absorption spectrophotometer. Results : The results were as follows: 1. The geometic mean concentrations of total subjects were 0.04㎍/g for Pb, 0.09㎍/g for Cr, 0.06㎍/g for Mn, 0.03㎍/g for Ni, and 0.04㎍/g for Cu. 2. The most highest mean concentrations of heavy metals in hair permanent agents by using type were Cr for wave agent and straight cream agent, Cu for setting iron agent, Cr and Cu for coating perm agent. 3. Metal most hlghest mean concentrations of heavy in hair permanent agents by type of color was green for Cu. 4. The mean concentration of Cu among 5 heavy metals in hair permanent agents by marker was most highest. 5. There was most statistically significant difference on mean concentration in hair permanent agents between domestic and foreign products. 6. The exposure amount of heavy metal concentration by one time using the permanent agent were 4.O㎍ for Pb, 9.O㎍ for Cr, 6.0㎍ for Mn, 3.O㎍ for Ni and 4.0㎍ for Cu. Conclusion : As above results author suggest to prepare the preventive program of health impairment due to heavy metal by long term chronic exposure to who were using the hair permanent agents hair designer and customers.

스테로이드가 신생 흰쥐 해마형성체 신경원의 퇴행에 미치는 영향

임경택,채희선,김성수,김경용,이원복 중앙대학교 의과대학 의과학연구소 1998 中央醫大誌 Vol.23 No.1

The influences of adrenal corticosteroid on the development and regression of the neurons of hippocampal and dentate were examined in the steroid overloaded neonatal rats. The results obtained were as follows. The regression occurred naturally in numerous dentate granule cells and hippocampal pyramidal cells, which was the apoptotic process. The apoptotic granule cells in dentate gyrus decreased in number with steroid overload, and this change was more prominent at 6 days than at 4 days. The decrease in the number of apoptotic neurons by steroid overload occurred only in the upper limb of dentate gyrus at 6 days. The gradient of regression in dentate gyrus had no relation with the gradient of neurogenesis, and the regression of hippocampal pyramidal cells decreased in the gyrus but not in CA regions. In conclusion, the cell death occurred in neurons of hippocampal formation, which was the process of apoptosis. The adrenal corticosteroid seemed to be influential significantly on the development and regression of the neurons.

간경변증 환자에서의 위 배출 시간

기주영,채희복,박선미,윤세진,정현용 충남대학교 의과대학 의학연구소 2003 충남의대잡지 Vol.30 No.1

간경변증 환자에서 소화기 증상의 정도와 울혈성 위염, 복수의 유무가 위 배출 시간의 지연과 관련이 있는지 알아보고자 하였다. 대상 환자는 2001년 3월 1일부터 2002년 5월 31일까지 간경변증으로 진단 받은 33명의 환자를 대상(평균연령 54.3세)으로 하였고, 정상 대조군을 위 장관 질환의 과거력이 없고 소화 장애등의 자각증상이 전혀 없으며 위 배출등에 영향을 줄 수 있는 약물 복용이나 전신 질환이 없었던 15명을 대상(평균 연령 30세)으로 하였다. 위 배출 시간검사는 50gm의 달걀 1개에 Tc^(99m)-tincolloid lmCi를혼합하여 고형질화 시킨 TC^(99m)-tin-colloid-steamed egg를 섭취한 후부터 single-head-gamma camera(Picker Co,. USA)을 이용하여 위 배출 시간 반감기(T1/2)를 찾아냈으며 위배출 시간은 T1/2의 평균±표준편차로 표시하였다. 위 배출 시간의 지연은 정상 대조군 T1/2의 mean±1 SD(45.0+12.7분) 이상으로 하였다. 정상 대조군(n=15)의 위 배출 시간은 42.64±16.80분이었고, 간경변증 환자군(n=33)은 42.54±20.80분으로 두 군 사이에 유의한 차이가 없었고, 울형성 위염 및 복수의 유무, 증상점수 4점을 기준으로 하였을 때 위 배출 시간은 두 군 사이에 유의한 차이가 없었다. 식도 정맥류가 있는 군(n=26)과 없는 군(n=7)의 위 배출시간은 각각 49.27±16.80분, 31.71±10.61분이었고, 위 정맥류가 있는 군(n=7)과 없는 군(n=26)의 위 배출 시간은 각각 53.14±11.71분, 43.50±5.85분으로 정맥류가 있는 군에서 위 배출 시간의 지연을 보였으나 통계적으로 유의하지는 않았다(식도 정맥류 p=0.654, 위 정맥류 p=0.991). 혈청 알부민 수치와 위 배출 시간 반감기는 서로 유의한 상관관계가 없었다(p=0.177). 결론적으로, 간경변증 환자에서의 소화불량 증상의 정도와 울혈성 위염, 복수의 유무에 따라 위배출 시간에 차이가 없었다. The purpose of this study was to evaluate whether delayed gastric emptying time(GET) was associated with the degree of gastrointestinal discomfort, congestive gastropathy, and ascites in patients with liver cirrohsis. Thirty three patients, aged 54.3 years, with liver cirrhosis and fifteen control subjects, aged 30 years, without gastrointestinal symptoms and history of gastrointestinal disease were participated from the first of March in 2001 to the 31st of May in 2002. For GET, solid phase gastric emptying was done with radionuclide scintigraphy using single-head gamma camera after ingestion of Tc99m tin-colloid-steamed egg. Delayed GET was defined as the half time period in GET(T1/2) longer than the mean value plus 1SD of controls (45.0+12.7min). GET between Control group and patients with liver cirrhosis was 42.64±16.80min, 42.54+20.80, respectively. Therefore, there is no significant difference. On the base of congestive gastropathy, symptom score '4', and cirrhosis, there is no difference statistically between two groups. GET measured in the group with esophageal varix(n=26) or without esophageal varix(n=7), was 49.27±16.80min, 31.71±10.61min, respectively. GET measured in group with gastric varix or without varix, was 3.14±11.71min and 43.50±5.85min, respectively. But, there is no difference statically between two groups. There was no significant correlation between serum albumin level and T1/2 of GET(p=0.177). This study shows that there is with no apparent clinical difference between gastric emptying time and liver cirrohtic patients with gastrointestinal discomfort, congestive gastropathy, and ascites.

장중첩증을 동반한 맹장 지방종 1예

홍의실,나병규,김민옥,유일영,채지영,채희복,윤세진,이상전,송형근,박길선,정현용 충남대학교 의과대학 의학연구소 2002 충남의대잡지 Vol.29 No.2

대장 지방종은 주로 우측 결장에 호발하고 특히 회맹판 부위와 맹장 부위에 호발한다. 또한 50~60대에 빈도가 높고 증상이 있는 환자에서 장중첩증이 높게는 40~50%에서 보고되고 있어 성인 장중첩증의 원인으로 중요한 비중을 차지한다. 특히 성인 장중첩증 및 장폐쇄의 중요 원인인 악성 종양과 임상 양상이 유사하여 감별진단이 중요하다. 저자들은 반복적인 복통을 주소로 내원한 환자에서 맹장의 4×5㎝의 점막하 지방종이 말단 회장부위와 반복적인 장중첩중이 발생했던 1례를 부분 절제술로 치료하여 양호한 임상 경과를 경험하였기에 문헌 고찰과 함께 보고하는 바이다. Lipomas are one of the most common benign nonepithelial tumors of the colon which are often detected incidentally by radiologic investigation or on operation. These tumors are usually without specific symptoms. Colonic lipomas occur most often in the right colon, particularly in the ileocecal valve and the cecum. Most patients are asymptomatic. but tumors larger than 2 cm tend to produce a change in bowel habit. abdominal pain. rectorrhagia and complications including luminal obstruction or intestinal intussusception. Diagnosis can be made by colonoscopy abdominal CT. MRI, or barium enema. We report a case of lipoma of the cecum that originated in the submucosa and presented as a intussusception in a 50-year-old woman with a brief review of the literature.

경간동맥화학색전술로 치료받은 간암환자의 생존율과 관련된 예후인자 분석

임정묵,이태원,박선미,윤세진,박길선,채희복,이헌영 충남대학교 의과대학 의학연구소 2002 충남의대잡지 Vol.29 No.1

Transarterial Chemoembilization (TACE) has been shown to be effective in patients with unresectable hepatocellular carcinoma (HCC) and can be applicable to patients with resectable HCC who reject operation. There have been studies concerning prognostic factors in patients with (HCC) undergoing TACE but they reported diffenrent prognostic factors from each other. The aim of this study is to estimate the survival rates and to determine which prognostic factors contribute to long-term survival after TACE of HCC. Thirty eight patients with HCC who had been treated by TACE were analized retrospectively. TACE was accomplished by hepatic arterial infusion of a suspension of lipiodol and anticancer drugs (Adriamycin), either alone or followed by gelfoam embolization. Male to female ratio was 4.4:l. Mean survival time was 463 days. Maximum survival time was 1,683 days. The overall cumulative survival rates at the end of the first and second years were, respectively, 54% and 38%. According to univariate analysis (log-rand scale test), variables significantly associated with survival were: tumor type, hepatic vein thrombosis, portal vein thrombosis, lipiodol uptake pattern, remained enhancement after TACE, AST, ALT, height and tumor size. Multivariate analysis (Cox proportional hazard model) for the significant variables in a univariate analysis revealed that the AST level, hepatic vein thrombosis, remained enhancement after TACE were statistically significant independent prognostic factors. The criteria of known contraindication may still be applied for TACE treatment of HCC. Additionally we should select the good prognostic patients without hepatic vein thrombosis and try to normalize the AST level if abnormal level before undergoing TACE. Thereafter, intensive chemoembilization to minimize the remained tumor is required to improve survival rates.

Current evaluation and management of alcohol dependence

( Hee Bok Chae ) 대한간학회 2011 Clinical and Molecular Hepatology(대한간학회지) Vol.17 No.3(S)

Current status of Liver diseases in Korea: Hepatitis B (제15권 제6s호)

Hee Bok Chae,Jong Hyun Kim,Ja Kyung Kim,Hyung Joon Yim 대한간학회 2009 Clinical and Molecular Hepatology(대한간학회지) Vol.15 No.6(S)

Current status of Liver diseases in Korea: Hepatitis B (제15권 제5s호)

Hee Bok Chae,Jong Hyun Kim,Ja Kyung Kim,Hyung Joon Yim 대한간학회 2009 Clinical and Molecular Hepatology(대한간학회지) Vol.15 No.5(S)

Hepatitis B virus (HBV) infection is the one of the most common causes of the liver diseases in Korea. Since the discovery of Australia antigen (hepatitis associated antigen, or HBsAg later), hepatitis associated antigen was tested widely. HBsAg was detected in 6.6~8.6% in 1980`s. Later, it decreased to 5.7% in 1990`s. Remarkably, seropositivity of the children deceased to 0.2% after the nationwide vaccination program. Although hepatitis B vaccines are highly effective, the failure rate of perinatal prophylaxis in babies born to HBsAg positive mother was reported to be 4.25%. Treatment of chronic hepatitis B was initiated after the introduction of interferon alpha. Lamivudine opened a new era of oral antiviral agent, and it has been widely used in Korea since 1999. Adefovir was proven to have a good efficacy for lamivudine-resistant chronic hepatitis B. Newer potent antiviral agents such as entecavir, clevudine, and telbivudine are available currently. Further studies are warranted for understanding factors influencing natural history, improving treatment outcomes, and overcoming vaccine non-response.